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Unequal justice: Few youth get the mental health help they need

Many youths who show up in Ontario’s courts have learning and mental health issues, but few get the help they need.

Psychologist Tracey Skilling and her team at the Centre for Addiction and Mental Health perform court-ordered assessments of youth involved in the criminal justice system. (Jim Rankin / Toronto Star) | Order this photo

Most youth that Justice David Cole sees will be in trouble only once or twice. Others, he calls frequent flyers, and it is these kids who are in serious trouble and end up in jail for some serious crimes.

Cole, of the Ontario Court of Justice, splits his time hearing youth and adult cases in northwest Toronto. He co-wrote the 1995 report into systemic racism in the province’s justice system.

Many youths who show up in court have learning and mental-health issues, and a very small fraction of those end up being sent for a judge-ordered mental-health assessment. It comes after a finding of guilt, after a possible mental-health issue has been flagged by a parent, lawyer, judge or probation officer — most of whom have no training in how to spot such issues.

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Psychologist and researcher Tracey Skilling is part of a four-person team at the Centre for Addiction and Mental Health that conducts assessments and draws up treatment plans.

In the Toronto area, youth in custody arrive in a bright fifth-floor interview room at CAMH’s Queen St. campus, usually in handcuffs and under guard, and most with a parent present. Others not in custody are seen here too.

“Most come from at-risk areas of the city and disadvantaged backgrounds,” says Skilling, 44. “Black youth are overrepresented in the juvenile justice system and that’s also true of our clinic. It is a reflection of the system, but it’s also true that almost all of the youth that we see come from impoverished backgrounds.”

Individual plans are drawn up and there has been follow-up to see how they have done. Of those who did access programs recommended by Skilling and her team, recidivism rates were much lower than those who received less of the recommended treatments, which include anger management and group sessions. Nearly all of the youth she sees end up accessing programs run in the community, as opposed to jail.

“If these treatment plans are being executed, you’re really having a huge impact on risk to reoffend,” she says. But, overall, “their needs are not being met as often as we would hope.”

She estimates only a small percentage of youth in the criminal justice system with health issues pass through her doors, meaning most don’t get specialized help.

Many important things are happening in the human brain between the ages of 12 and 25. Some of it is very much influenced by environment. Stan Kutcher, a Halifax-based doctor who holds the Financial Chair in Adolescent Mental Health, has spent a career studying young minds.

Kutcher says some provinces, Ontario among them, are taking the right steps to improve youth mental health.

Jail, however, remains one of the worst places to deliver positive rewiring programs that can truly have an impact, he says, and he does not hide his contempt for the federal Conservatives’ get-tough-on crime initiatives. (Kutcher ran unsuccessfully for a seat in the last federal election for the Liberals.)

“What do we do with kids who have two strikes against them already? We put them into penal situations,” says Kutcher. “And what kind of environment is there? Exactly the kind of environment that predisposes them to a lifetime of crime, so that they never learn.

“If we wanted as a society to create specifically the things that would lead to the worst possible outcomes in kids we would set the system up the way it’s set up right now. It’s frustrating.

“Twenty years ago, people may have had an out by saying we don’t know the data, but we do know the data now. And we’re going to have to choose, are we going to be directed by what the data tells us or are we going to be directed by some kind of long-held ideological system?”

Justice Cole says his wife, Ester Cole, a child psychologist, “jokes with me from time to time, ‘Why did they spend all of the money on your system? If you can give that money to me for the first three years of life then maybe I can do something.’ And she’s absolutely right.”

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